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139 De-Ron-Kel Ln DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issutid in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name / r°r �,� '/ /j��"'�D to .!P(/", � N2 8 1 7 4 Location ,�/� �. �. . �� — f' l / . � � _ �, ,�• / � l Subdivision Name, Lot No. Sec. or Block No. Lot Size -- House — �� Mobile Home __-- Business _— Industry 1�/r No. Bedrooms Baths . --.No. �_ No. in Family _ Public Assembly Other t s Garbage Disposal YES ❑ NO i Specifications for System: Auto Dish Washer YES Q NO ❑ v2 -Z-) Auto Wash Ma-hive YES J NO ❑ / / ii" _ Type Water Supply —r�>P/l - — --- �1 )22 'This permit Void if sewage system described below is not installed within 5 years from date of issue. .This permit is subject to revocation if site plans or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM. E / T.._..R__._ f Improvements permit by *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30.9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion.Telephone Number: 704-634-5985. Final Installation Diagram: 9D led by --� 4b f i Completion- /`.A�'�'l 'G Certificate �f Camp et •n- .— Date _ 'The signing of this certificate shall indicate that the system described above has been,installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. ffi ran DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ; *_NOTE:Issiry in Compliance With Article II of G.S.Chapter 130a --S� Sewage Systems Permit Number % 'i� ' /�' ` r� .�� /i'' N o i Name , , / / — Date f% r I I/ Location ,1 �:' 'r� r�` - r �'�J,:r;/ • .� /'- f S' r /%.�/.!_ d f ✓/, :e ,�i'°/ /� 4%, -X3 09-- 1 - I-A/, - Subdivision Name Lot No. Sec. or Block No. Lot Size ----_ House _�'� Mobile Home --- Business —_ Industry No. Bedrooms T--.No. Baths —lig— No. in Family_ Public Assembly` Other Garbage Disposal YES ❑ NO p Specifications for System: ` Auto Dish Washer YES NO ❑ !%(1- Auto Wash Ma^hine YES NO ❑ ,.fie TYpe;.Water Supply *This permit Void if sewage system described below is not installed within 5 years from date of issue. This permit is subject to revocation if site plans or the intended use change ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS SYSTEM, Improvements permit by _ *Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M., 1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634-5985. Final Installation Diagram: �,1 9d i1';t3tIed by -1 Certificate of Completion Date _ 'The signing of this certificate shall indicate that the system described above has been installed in compliance with the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERM �q /�+ U�1ftld� Davie County Health Department R EC E U Environmental Health Section Al P. O. Box 665 J U L 15 1994 i� Mocksville, NC 27028 kit 4 --------------- 1. Application/Permit Requested By P 3 Home Ph - oc 0 O Mailing Address one/ o ` ' sV ( �I r1 C. -Arlo o1 � Busineg PU e � l 2. Name on Permit if Different than Above (f f 3. Application for: )4eneral Evaluation ❑Septic Tank Installation PermitC CO-10 Sce. ( -F Pet-k$) 4. System to Serve: louse ❑ Mobile Home ❑ Place of Public Assembly ❑ Business ❑ Industry ❑ Other ❑ Unknown 5. If house, mobile home: Subdivision Section Lot # ❑ Basement/Plumbing No. of People -� ❑ Basement/No Plumbing No. of Bedrooms _ _ , -Washing Machine No. of Bathrooms I ❑ Dishwasher Dwelling Dimensions ❑ Garbage Disposal 6. If business, industry, place of public assembly, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers Water Usage Figures 7. Type of water supply: ❑ Public I-EI-Private ❑ Community 8. Property Dimensions age Dispo al Contract 9. Do you anticipate additions/expn of the facility t�sytem is inten ed d C6 serve? ❑ Yes 'No If yes,what type? 'NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. Directions t�Property: Z,Z-4 A g-dW qv This is to certify that the information provided is correct to the best of my knowledge, and I understand I am responsible for all charges incurred from this application. gzzDATE 0 SIGNATURE CONSENT FOR SITE EVALUATION TO BE DONE ON ABOVE DESCRIBED PROPERTY MUST CHECK ONE: %1. 1 OWN the property. ❑ 2. 1 DO NOT OWN the property. If you checked Box #2, the rest of this form MUST be completed by the owner or a person authorized by the owner: I hereby give consent to the authorized representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine said site's suitability for a ground absorption sewage treatment and disposal system. DATE SIGNATURE DCHD(1/93) t j. DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Soil/Site Evaluation NAME _ rl GUG`l DATE EVALUATED �� ADDRESS PROPERTY SIZE t PROPOSED FACIILTY ' ®2!F C LOCATION OF SITE / /NN Water Supply: On-Site Well Community Public Evaluation By: Auger Boring L/ Pit Cut FACTORS 1 2 3 4 Landscape position Slope % HORIZON I DEPTH r1l ,• Texture group ,( Consistence Structure Mineralogy HORIZON II DEPTH JVs� Texture group (1 Consistence ,` Structure /- Mineralo HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE .-7-7--=. = SITE CLASSIFICATION: X-4/94 "O-� " EVALUATED BY: LONG-TERM ACCEPT C RE: '_2 / OTHER(S) PRESENT: REMARKS: !`�L �' �f/�eS�Z�IA C!/�/�t/ ✓ r�Jt/ !S �4 LEGEND Landscape Position R-Ridge S-Shoulder L-Linear slope FS-Foot slope N-Nose slope CC-Concave slope CV-Convex slope T-Terrace FP-Flood plain H-Head slope Texture S-Sand LS-Loamy sand SL-Sandy loam L-Loam SI-Silt SICL-Silty clay loam, SIL-Silty loam CL-Clay loam SCL-Sandy clay loam SC-Sandy clay SIC-Silty clay C-Clay CONSISTENCE Moist VFR-Vcry friable FR-Friable FI-Firm VFI-Very firm EFI-Extremely firm Wet NS-Non sticky SS-Slightly sticky S-Sticky VS-Very Sticky NP-Non plastic SP-Slightly plastic P-Plastic VP-Very plastic Structure ,3C-Single grain M-Massive CR-Crumb GR-Granular ABK-Angular blocky SBK-Subangular blocky PL-Platy PR-Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 DCHD(01-901 NOON■E■■E■EEE■■■■■e■■■■■■■■■■■■■■■■■e■■O■■■■■■■■■■■■■■■■■■■■■■■i ■ ■■■■■■■■■■■■■■■E■EEE■■■■E■EE■■■■■■■■■■E■EEEEEE■E■EUEEEEEE■EEEeEEE■ ■■■■■■■■■■■■■■e■■■■■■■■■■■E■E■■E■■■■■ENE■■eE■■■E■Ei■EEEEEEE■■■eEEe■ ■■■■■■E■■■■■r�e■�reuEEErie/EEE■E■EE■■■■E■EEEEEEEEEriEEEEEEEEEE■EE■e■ ■■■■■■■■■■■■riE■n%■■■■■ir�r■EEE■EE■�■■e■■■■■■■■es■ee■■■■■■■■■■■e■■■■ ■■■■■■EEEEE■c.■■i■ur�■ue■■■■■CE■EEE■E■■■■1EEEeEEEE■■1DEEEEEEEEEEE■E■E■ ■■■■■■■■■■■■■■■■■■■■■■■EEE■ENEEEEE■■■■1�■�■■■■■■/■■e■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■Ii1■■■■■■■■■■■■■■■■■EEE■It■■■■■■■■■1■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■EEE■■EEE■EDEEEEEE■�■■■■I■■■ND■■■■IID■■■■■■EO■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■It■■■■■■■EI/■■■e■■■■■■■■EOEN■■ ■■EEEEEE■EEE■EEEEE■ENE■aE■EEE■EEEEE■eNEEEEENEEE.DEG■EEEEEEEEE■EEe■ ■■■■■■■■■■■■■■e■EEEEE■■■EEE■■■EE■EEEE■iEEEEEEEEr1EEEEEEEEEEEEENE=ED■ ■EEEEEEHEEEEE■■■■■■Ee■e■■e■■■■■ ■■er�■E■■E ■erg■eEEE■■E■■EE■E■ ■■■ ■■■■■■■■■■■■■■■■■■■■eE■eEE■EEDEE�■■F11■■DD■mE■EE■F■E■DE■■EEE■■■■■■ NOON■■e■■■■■■■■■■EEE■■Ee■■■■■■■■■■■ED1�■■■■■■Elr�■■■■■■■ ■■■■■■■■■Ee■ ■■■■■■■■■■■■■■■■■■■■■EE■EEE■EEEE�■■■1E■■■■■■a►�ENEEEEE■Ei�E�iEEEE■EE■ ■NOON■EE■■■■■■OD■■■■■■Ee■E■EEE■■ ■■rl■EEEEEt��f111H■EE■■■Ei■■■■■■■■■■■ ■EEE■EEE■■EEEEEE■E■EE■EEEEEEEEEEE■■Eii■EEEE►�.EriDEEEEEEEEEi■■ FEOFFEE ummoso■GlMENNEN 3G�IGGCGGGGGGGGG GI�GGGC[ir1GIAMUME MEMOMI%"IlILj oG ■■G■■■■■..G■■■■■■■..EEC■■E■■..EG■■E■E■..DEGE■■■■..EGE■N■■■..EEG■■E■■..■G■■■■E■..■EGE■E■■■.E■EE�■■■..■E%■�ta■..Ir■EE�E■Ei..lrG■E■rrE■..u+EG■N■E■..rEF■■■E■..I■1■■E.■.■'1■/■■E■..11/u■■■H■..1■■E■E■..I■EF■E■..ID■N■EE■..■■EE■E■..■■■■EEH..■■■ENE..■■■ENE■..■■■■■EO..■■■E■EO..■■■EEE■..■■■E■E■..■■■E■■■..■■■E■E■..■■■EEE■..■■■=■e■..■■■G>rI►..,S�iF■/e■EE..I0 l■E■r��■t,i�!■■EN�l.>�.tJ■■■E..t�.y1�■■Ir■.�■1�:%HN■..)I■tG�■O.■�E■L■rtIE1■1►n�rIENu■E■■■■■■E■■D■■■O G SEEMS mom■■■■■■E0■EOG■ ■.D■■E■ ■M■FOII■e■■eEEE■■■ Go �■ GiEGGG00o N ■■�E�Jim ..■■■EEeeE.i■■ ■■■r� % tGE■■■ENG ■OD■DII■E■■EG■E■■ ■■■■Orr■■■■■ ■■DD E■■E■ MEN Irpo■F■■■ NONELMEm:iEE ■OE■ ■■■■■■■■■■ Clamo ... ... . ■■■■N SOMEONE son mom G.'.N■ G�:Gg G:: ::GME ■■■■■EEEE■■■■EEEEEEE■■■EEEiir■■Erl■EEOEHE■I■ GEED■GGr.■EO suEND■E■EE ■■EDEEEEE■DEEEEF■EEEEE■ONOOEEOOI/�EOEEOOI/ENE■FEED/:NOOEO%E■E■■ O■E ■■E■eE■E■■■■■■■■■EEEEtrr■■■■■■■E■■ ■O■■E■IreEE■■EEE%EEEE/EEE■Ee■ENE■ D ■IEEE■■EEE■E■■ IMMUNIMMUM EH/� ■I■■FE■E■■EOE■■■■ .........................C...............■.......,.....■■ED.e■E.FE ■eE■eE■EEE■■■■EEE■■■G■■■■■■■■r►■E ■EE■eEEe■r�■■■IEEEEEEE■E■EE■■EO■■ ■■■■EEE■EEEEEEEEEEE■E■EEE■E■F■i■E ■O■E■■■■rDEomMEN■E■E■■■■ED■■■DD■ ■e■EEE■FEE■■■EE■■■■■■■■EE■E■■■EE■■EE■��EE��■DEEENEENFE■E■■N■■E■E■ MEMO Davie County Nealtl De artment and �fome .7�ealtFr yen cy 210 HOSPITAL STREET/P.O. BOX 665 MOCKsvILLE,N.C. 27028 PHONE:(704)634.5985 August 3, 1994 r Mr. Roger Marty Powell 2203 Milling Road Mocksville, N.C. 27028 Re: Site Evaluation De-Ron-Kel Drive Dear Mr. Powell: As requested, a representative from this office visited the aforementioned site on August 2, 1994. Based upon the information provided on the application for a site evaluation and after the evaluation was completed, the site was found to be provisionally suitable for the installation of a modified, oversized on-site sewage disposal system. If you have any questions, please feel free to contact this office. Sincerely, Ae4s'e V.0f, ikolw�A. Robert B. Hall, Jr. , R.S. Environmental Health Section RH/wd Enclosure